Bladder Cancer
Related Subjects:
| Urothelial Tumours
| Haematuria
| Acute Urinary Retention
| Anuria and Oliguria
| Bladder Cancer
|Penile Cancer
| Renal Cell Carcinoma
| Benign Prostatic Hyperplasia
📖 About
- 🔹 Bladder cancer is common in older adults, particularly men (≈3:1 male:female ratio).
- 🚨 Red flag: Any haematuria (visible or non-visible) must be investigated urgently.
⚙️ Aetiology
- Most cases present as superficial tumours (non–muscle invasive bladder cancer, NMIBC).
- Risk of progression depends on tumour grade, size, and multiplicity.
🔬 Pathology
- ~90% are urothelial carcinomas (transitional cell).
- ~8% are squamous cell carcinomas (linked to chronic irritation e.g. schistosomiasis 🐌).
- ~2% are adenocarcinomas.
⚠️ Risk Factors
- 🚬 Smoking → accounts for ~50% of cases.
- 🏭 Occupational: aromatic amines (dyes, rubber, leather), benzidine, petroleum, paint, and metal industries.
- 💊 Therapy-related: Cyclophosphamide (↑ x10 risk), pelvic radiotherapy, some Chinese herbal medicines.
- 🦠 Infective/irritative: Schistosomiasis (especially SCC type).
🩺 Clinical Features
- 💉 Painless visible haematuria – the classic hallmark.
- 🧻 Storage symptoms: frequency, urgency, dysuria.
- ⚡ Pelvic pain or obstructive uropathy in advanced disease.
- 🪫 Systemic features: uraemia, weight loss in late stages.
🔍 Differentials
- UTI with haematuria.
- Coagulopathy causing bleeding.
- Renal cell carcinoma or upper tract urothelial cancer.
🧪 Investigations
- 🩸 Bloods: FBC, U&E, LFTs, ESR/CRP.
- 💧 Urinalysis & urine cytology (may detect atypical cells, not definitive).
- 🔎 Cystoscopy with biopsy – gold standard.
- 🖼️ Imaging: CT urogram (abdomen/pelvis), USS (screening), IVU (historical).
- 🦴 Bone scan if bone pain or ↑ALP suggests metastases.
💊 Management
- 🌱 Superficial bladder cancer (NMIBC):
- Treated with TURBT (transurethral resection of bladder tumour, including detrusor sampling).
- ± Intravesical therapy: chemotherapy (e.g., mitomycin C) or BCG immunotherapy.
- Requires regular cystoscopic surveillance.
- 💉 Cystectomy if high-risk or multiple recurrences.
- 🧱 Muscle-invasive bladder cancer (MIBC):
- Gold standard: Radical cystectomy (with ileal conduit or neobladder).
- Radiotherapy as an alternative (often in frailer patients).
- 🎯 Neoadjuvant cisplatin-based chemotherapy can improve survival.
- 🌍 Metastatic bladder cancer:
- Palliative chemotherapy (cisplatin-based if renal function allows).
- Palliative radiotherapy for local control, pain, or haematuria.
📚 References
